View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0938-0354	ICR Reference No: 200209-0938-008
Status: Historical Active	Previous ICR Reference No: 199905-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/15/2002
	Date Received in OIRA: 09/26/2002
Terms of Clearance: This information collection is approved for an additional three year period. However, CMS must remove OMB's name and address from the PRA burden statement by the next reprinting of this form.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2005	11/30/2005	11/30/2002
Responses	56	0	56
Time Burden (Hours)	1,568	0	1,568
Cost Burden (Dollars)	15,000	0	15,000

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.